The Rio 2016 Summer Paralympic Games kicks off today and 45 athletes with physical and visual impairment will represent South Africa in 10 different sports codes.

Probably not all 45 athletes will return with medals, but each of them deserves one, considering all the challenges they have had to overcome just to compete on that level.

In addition to their impairment, Paralympic athletes face a myriad of physical and emotional challenges which serves as barriers to improved performance and progress. Six Paralympians from the Maties Athletics Club obstacle share their stories.

Paralympic sprinters Fanie van der Merwe, Charl Du Toit, Arnu Fourie and Dyan Buis training at the Coetzenburg Athletics Stadium in preparation for the 2016 Rio Paralympic Games.

Visual impairment

Pictured here is 100m and 400m sprinter, Ilse Hayes, with trainer Nico Koutakis ensuring she keeps her form during training. Hayes has a degenerative eye condition, called Stargard's disease, which affects a person's central vision. Hayes currently has between 5% and 10% vision.

It can be difficult for visually impaired athletes to learn new techniques. "Normally you would just show someone what to do, but if they can't really see you, you have to find a different way to do that – you can either help them move their bodies into the right position, or do the movement while they feel what you are doing," says Dr Lara Grobler, a post-doctoral fellow at the Institute of Sport and Exercise Medicine (ISEM) at Stellenbosch University's Faculty of Medicine and Health Sciences.

Another unusual obstacle for visually impaired athletes is shadows. Often they can only see in shades of light and dark, and a shadow can look like an object moving towards them which can cause them to jump out of the way. "This can impact on their performance or cause accidents on the track," explains Prof Wayne Derman, Director of ISEM and team doctor for the Paralympian team at Maties.

Amputation

Prostheses can be used to correct asymmetries caused by amputation. This is the case with the 200m & 400m Paralympic sprinter, Anrune Liebenberg, who runs with a weighted prosthesis to balance out her lack of a left forearm. Here she is seen training with the team doctor, Derman, looking on.

"Your hand and forearm make up about 2% of your body weight, and if it is missing on one side, you are off balance. The asymmetry actually increases with the increase in torque, so it is worse when you run – especially at the speed these athletes are running," says Grobler.

Liebenberg's prosthesis corrects the imbalance in the weight of her two arms, helping her to preserve energy while running, which makes her go faster. 

"You have to find a way to compensate for the asymmetries, but also work within the athlete's natural ability," says Grobler.

The 200m Paralympic sprinter, Arnu Fourie, dons his running blade during a training session at Coetzenburg Athletic Stadium in Stellenbosch.

There are several challenges to "blade running". The connection point between an athlete's leg and the prosthesis creates a type of "joint" where there isn't supposed to be one, says Derman. The force applied to that area when running is between four and six times the athlete's bodyweight, and the area is prone to injury.

A silicone liner is placed over the stump to protect the skin and create better adhesion between the leg and the prosthesis. When the athletes exercise, perspiration collects under the liner, and it has to be removed, cleaned and dried several times during a training session to prevent irritation and infection in the area.

"Over longer distances, sweat build-up and friction can cause the prosthesis to come loose completely which will cause the athlete to fall," says Grobler.  

Choosing the right prosthetic blade is a major challenge and requires a lot more 'science' than just size and comfort. Some prosthetics will mimic the action of the abled leg, while others challenge the unaffected leg. "You have to find something that is going to create the best performance. For example, if you pick a prosthetic that is too stiff, the athlete might perform better, but it might be bad for his or her back," Grobler explains.

Athletes use different prosthesis for different activities, for example, they use the blade to train on the track, but might have another "leg" for the gym. They may use another prosthesis for day-to-day use.

Cerebral palsy

Dyan Buis, Fanie van der Merwe and Charl du Toit are all Paralympic sprinters with cerebral palsy (CP) competing in the 100m and 200m distances. Du Toit also races the 400m distance.

CP is a brain condition that affects body movement, muscle coordination, and balance, and it can cause muscles that are spastic, weak or contracted, resulting in the person walking with a limp. Athletes with CP are categorised differently depending on which sport they are involving in and the severity of their affliction. In Para-sport, the higher the number at which an athlete is classified, the better function he or she has. For example, Buis is classified as a T38, while Van der Merwe and Du Toit are both T37s, whilst athletes categorised between T31 and T34 participate using wheelchairs.

ISEM researcher and biokineticist, Dr Phoebe Runciman, has extensively studied the relationship between exercise and CP. Her research has shown that athletes with CP perform toward the level of the side most affected by the CP hemiplegia (paralysis of one side of the body). Therefore athletes should focus their training on strengthening the weaker side of their body to improve their performance, as Du Toit is doing here.

Runciman's research further suggests that doing regular exercise from a young age is beneficial to people with CP, and will improve their strength, balance, mobility and other functions.

"Historically people with CP were institutionalised and segregated from society. Today that viewpoint has changed, but often the only exercise children with CP are usually exposed to are "play-based therapy" or walking," explains Runciman.

"In our research we have proposed that parents expose their children with cerebral palsy to high level exercise from a young age.

"These guys were doing able-bodied sport from a very young age. Their parents didn't limit them because they were disabled. They encouraged them to play sports like soccer, cricket and rugby with their able-bodied peers. And today they are elite athletes," says Runciman.

Fanie van der Merwe held the 200m world record in his class.

 "It is true that this group of athletes are minimally affected to begin with, but you can get someone that's in a wheelchair into a proper exercise routine at a local training facility or at school, instead of letting them sit on the side line. That would allow that individual to lead a functional lifestyle with less effect of CP and better quality of life in all areas."

"If you are disabled, a great form of empowerment is to get involved in sport or exercise, which can improve the quality of life for many years into the future," says Runciman.

Photos: WIL PUNT – PEARTREE PHOTOGRAPHY